Pharmacy drug store chains have traditionally relied heavily on insurance companies to recover payment for prescription sales made to patients. Although some prescription sales may be paid for in full by a patient, the vast majority of prescription sales are paid for, in large part, by the patient's insurance company, herein referred to as a “third party payor.” The third party payor may include commercial insurance companies, health maintenance organizations (HMO), preferred plan provider organizations (PPO), government entitlement programs (Medicaid), indemnity insurance companies, etc. A third party administrator (TPA) or obligor that services prescription plans on behalf of another may also be included in the group of third party payors. Typically, the patient pays a portion of the total cost of the prescription at the time of delivery. The patient then expects that the remainder of the total cost of the prescription will be paid by his/her third party payor. Accordingly, timely and accurate prescription payment by the third party payor is often critical to the pharmacy's success.
Unfortunately, some of the payments due from the third party payors are not paid due to a variety of reasons. As a result, the pharmacy drug store chain is often required to identify, investigate, resolve and collect payments for outstanding, unpaid, and/or rejected prescription claims. The current methods of recovering outstanding, unpaid, and/or rejected prescription payments from the third party payors, however, are labor intensive.